Pediatric EM Myths - Fox

  Myth #1 - "Kids aren't little adults."
    - Less a myth and more a good idea gone awry.
    - We don't need to consider kids to be like aliens.
    - Just take into account the anatomic and physiologic differences, but don't let them frighten you.
    - They are a unique patient population (similar to all of your other unique patient populations).

Myth #2 - "IVF are faster than ORT."

    --IVF are effective and often expected, but not always easy.
    --Painful, makes unhappy parents and unhappy patients.

    --ED LOS: ORT = 225 vs IVF = 358.

Myth #3 - "Lidocaine makes LP worse."

        -- Neonates do feel pain, have greater sensitivity, and are more susceptible to long term effects.
        -- EMLA is safe, reduces pain during LP.
        -- Makes your job easier!! (keeps them from wiggling)

Myth #4 -  "To hold for LP, bend them into a donut."

        -- Don't do this.
        -- Hyperflexed neck leads to SUBOPTIMAL AIRWAY ALIGNMENT.
        -- Best airway position is sitting up with legs flexed and neck neutral.

Myth #5 - You can adjust for RBCs in the "Bloody tap."

        -- Correct with 1:500 for WBC, etc etc -- these formulas don't work.
        -- When concerned for meningitis, be conservative WBCs.
        -- Do not adjust the WBC for the RBC in a traumatic LP.  Use the total WBC.

Myth #6 - "Nebulizers are better than MDI."

        -- Evidence shows that MDI are AT LEAST as good as nebs, if not better.
        -- MDI is faster and reinforces good MDI use, which can help prevent patients from needing to return to the ED.

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